Dental practices lose most of their money at the medical crossover.
Plenty of what you do is medically necessary and payable by a medical plan. Billed only to dental, it is capped by an annual maximum that runs out in March.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Dental claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Medical crossover never attempted
Surgical extractions, biopsies, sleep appliances and trauma are frequently medical claims. Sent to dental only, they hit the annual maximum and stop.
- Frequency limits tripped
Cleanings, radiographs and fluoride all carry frequency rules that vary by plan. One visit too early is a full denial, not a partial payment.
- Narratives missing on major work
Crowns, periodontal work and implants are routinely reviewed. Without the narrative and the radiograph attached, the review defaults to no.
What we bill for Dental practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Dental accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- A dental coder, not a general one
The coder assigned to your account works dental every day. They already know which of your payers do what, and they are watching CDT to CPT crossover, frequency limits and pre authorization.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in dental it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your dental claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Dental practices
- Coders who work dental daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Dental billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Dental service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Dental practices ask
Can you really bill medical for dental work?
For the cases that qualify, yes, and it is the single biggest change most dental practices see. We will tell you honestly which of your procedures qualify.
Do you handle predeterminations?
Yes. For major work it is usually faster than appealing afterwards.
Can you track patient annual maximums?
Yes, so treatment plans are sequenced against what the plan will still pay this year.
Do you work with dental practice software?
We log into your system and work inside it, whichever one it is.
Have a dental coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.